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How to Have a Courageous Conversation with an Older Adult

Dear Dad, I am writing a letter to you, because there are some things I had wanted to tell you, but I just could not find the courage to say them. In fact I could not even figure out how to get started. It isn’t like I had not tried to say them before, because I had; but I just couldn’t find the words. The last time we talked, I backed off because I did not want to hurt your feelings. I couldn’t imagine this would be our last time to talk. Now, you are gone; and I am left with what I wish I had said to you while you were still living. So now I am writing this letter to say them to you now. Hopefully, by the time I have finished this letter, I will never again have to regret what I did not say to you.

Thus began a letter written by a parishioner who had requested help in processing the guilt and grief he was feeling at his dad’s passing. I had recommended that he write this letter to his dad to help him understand his feelings. His letter is a reminder of how hard it is to have some conversations with those we love. I have kept a copy of that letter to remind myself and to encourage others to have these important courageous conversations while people are still living.

Courageous conversations with loved ones are difficult for a variety of reasons. Every conversation in an intimate relationship involves risk, because we can be misunderstood, because we might be rejected as a result of the conversation, and because the future course of the relationship is on the line in conducting the conversation in the first place. In addition, courageous conversations are difficult because they require us to empathize with the other person and consider how the conversation might affect him or her. These difficult conversations often involve conflicts and competing needs, beliefs, values, and desires.

Courageous Conversations and Older Adults

Courageous conversations with older adults are risky. Rightly or wrongly, we presume with younger people there is less urgency to “fix” the relationship if a conversation produces hurt feelings, misunderstandings, or even the rejection of the relationship. The older the person, the greater seems the risk of these conversations. However, the need is greater as well. Conversations with older adults often have high stakes because there is often a deep investment in the relationship. Often, there is a lifetime of shared history, patterns of interactions, and roles that are hard to overcome, making the conversation harder and more risky. No one wants to throw a lifetime of history away. Moreover, the kind of role a person has with an older adult determines the risk involved. Obviously, a conversation between an adult child and a parent is riskier than a conversation between neighbors.

1) Prepare and anticipate risks.

Most of us are risk averse. So the first rule of thumb in having these conversations is to anticipate the risks involved and decide how much risk we want to take on. Most of us get into trouble when we take risks because we are overly optimistic about our chances of getting the outcomes we desire. A great place to begin is to determine how we can live with the worst-case scenario. When we plan for this, we can proceed with risky conversations because we are already prepared to live with the results.

Another way to make the risky conversations easier is to determine our risk tolerance through the help of a simple question: “Do the rewards outweigh the risks?”

2) Empathize with the other person.

One of the best aids to risky conversations is putting yourself in the other person’s shoes. If you have to hear bad news, would you rather hear it from someone who cares for you and is sympathetic or from a stranger or someone who doesn’t care about you? This is why this step in the process is so important.

What is it like to hear what you are going to tell someone? Is he or she afraid, lonely, and sad? Is he angry, shocked, or remorseful? How does this affect her life in the long run? Is there something to hope for? Does the individual have expectations and unfulfilled desires? These are the types of questions to ask yourself before having the tough conversations.

One helpful tool to take you beyond your own perspective concerns the 3 Is: Identity, Independence, and Intimacy. Ask yourself how the conversation you are about to have with an older adult will affect that person in 3 areas: Identity, Independence, and Intimacy.

One example of a 3-Is conversation with an older adult might concern giving up driving. Not driving says to the older adult that he is no longer the virile person of his younger years, which concerns his identity. Not driving also takes away his independence. Finally, taking away the keys threatens an older adult’s ability to spend time with friends, so intimacy takes a hit.

When an older adult is considering giving up driving privileges, it is crucial to help arrange for alternative transportation so that the older adult is not also giving up friends and activities and becoming isolated.

3) Use "what-if scenarios" to jumpstart conversations.

Getting this conversation going may be easy or hard, depending upon the individual. But it is easier to have the conversation as a “what-if scenario” when it is theoretic and may never happen than when it is a reality. A good way to begin such a conversation is to say, “Have you given any thought about when it might be time to use public transportation?” or “If you reach a point when driving is no longer fun or economical, then please call me, I’d like to help.”

4) Offer alternatives and allow the individual to make choices.

Another conversation involving the independence of older adults centers on the need for high levels of care. Higher care levels may mean moving to a nursing home or accepting home health care. Confronting a loved one with this need is not helpful because it says to the individual that he or she has limited capability. That reduces the person’s self-worth. One way of making this conversation less threatening is to allow the individual to make the choice. This requires preparation in advance to offer alternatives so the older adult sees the wisdom of the choice among alternatives. This kind of conversation is best held long before care becomes necessary. It also allows the older adult time to grieve the losses involved and to begin to see worth not tied to performance and abilities in life.

Alternatives are important in any conversation. One of the complicating factors in these conversations comes about because of role reversal, in which the child takes on the role of being the authority, and the parent or older adult takes on a receiving role. This change of roles often results in conflict and guilt.

One of the conversations many older adults are robbed of having centers around their physical health and visits to doctors. Many dementia patients are never told of their diagnosis. The same is true in terminal cancer diagnoses, where the prognosis is often not fully shared with the patient but is shared with the patient’s significant others. Medical personnel are human like the rest of us, and so they wish to avoid the tough conversations too. No one wants to tell someone her test results means she is going to die soon.

We cannot make those decisions for older adults. Others avoiding a conversation doesn’t mean we should enter the conspiracy of silence. In families, often there are alliances and partnerships that develop in which conspiracies of silence remain. It important to ask if the silence is caused by the fulfillment of needs by those who are silent or if the silence is dictated by the needs of the older adult patient.

5) Ask questions that honor the older adult's perspective.

The most difficult types of courageous conversations with older adults involve those of death or dying. Not only are these very necessary conversations, but they are often the conversations that older adults really would like to have with us. Older adults facing their mortality need to talk. Often, the toughness of this conversation lies with us, not with the older adults. This conversation is made more difficult because until circumstances force us into the conversation, we simply do not know where to begin.

One strategy to invite this conversation is to honor the older adults’ perspective by sharing our own questions about death and dying and asking them to talk about their own beliefs, experience, and wisdom. Typical ways to break the ice is to ask, “Do you ever wonder what is out there for us after life?” Or “I have been thinking about this a lot lately. What do you believe about death and the afterlife?” Give them time to become comfortable opening up to you about this area by occasionally reminding them of the opportunity.

There are other helps for this conversation. The book At the Edge of Life by Dr. Richard Morgan has conversation starters about death and dying and questions designed to elicit open-ended discussions. The Office on Aging and Older Adult Ministry offers funeral pre-planning guides, formats for recording a spiritual autobiography, writing a will, and planning a funeral. These instruments, when competed, can be shared, which opens up these troubling conversations.

6) Be an active listener.

The most necessary component for any of these difficult conversations is the ability to actively listen to the older adults, not the ability to express ourselves. Many older adults have lost their significant others, so they do not have many people who will actively listen to them. This is especially so if what they say is disagreeable or the way they say it is difficult to hear. Perhaps the most courageous gift we can give older adults is active listening. Courageous Conversations require us to put our feelings aside and challenge us to maintain our love for other people.

Courageous Conversations are courageous when we express our love for others in having the conversation. They may make us uncomfortable, may be risky, and they may not turn out the way we would like, but having the conversation is a way of giving our older adults a gift of love.